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How to Get Sleep in Anxious Times | Dr. Donn Posner

Jul 27, 2020 1h 18m 22 insights
I don't know about you guys, but my sleep has suffered quite badly during the last few months. Today's guest really got me thinking about this issue in a whole new way. First, he normalizes the sleep problems many of us are having. If you're sleeping poorly right now, he says, don't freak out; it is natural and normal. Second, he has a bunch of tips for how to deal with insomnia, some of which I had never heard before and am already starting to operationalize in my own life. His name is Donn Posner. He's one of the leaders in the field of Cognitive Behavioral Therapy for Insomnia. His titles are: Founder and President, Sleepwell Consultants, and Adjunct Clinical Associate Professor, Department of Psychiatry & Behavioral Sciences at Stanford University School of Medicine. Not only did he answer all of my questions, but we also played him some listener voicemails. One last thing to say before we dive in: our episodes this week have a theme: primordial needs. Today we're doing sleep; Wednesday it's sex. So it's a fun week here on the show.   Where to find Donn Posner online: Website: https://www.sleepwellconsultants.com/ Books: https://www.sleepwellconsultants.com/publications   Today is the first day of the Summer Sanity Challenge: a free 21 day meditation challenge. The goal here is to help you build resilience so that you are less buffeted by circumstances you can't control -- and are therefore calmer, happier, and better prepared to show up the way you want to for your family and your communities. To join the challenge, you can visit tenpercent.com/challenge.   Other Resources Mentioned: Society of Behavioral Sleep Medicine: https://www.behavioralsleep.org/ American Academy of Sleep Medicine sponsored site to search for local accredited sleep centers: http://sleepeducation.org/find-a-facility   Additional Resources: Ten Percent Happier Live: https://tenpercent.com/live Coronavirus Sanity Guide: https://www.tenpercent.com/coronavirussanityguide Free App access for Frontline Workers: https://tenpercent.com/care   Full Shownotes: https://www.tenpercent.com/podcast-episode/donn-posner-268
Actionable Insights

1. Don’t Panic About Poor Sleep

If you are currently sleeping poorly, don’t freak out, as it’s a natural and normal reaction to stress and often resolves on its own.

2. Consistent Wake Time is Key

Maintain a consistent wake time, getting up at the same time at least five days a week, as it’s the single most important structural input for entraining your internal biological circadian rhythm.

3. Don’t Compensate for Bad Sleep

Do not compensate for a bad night’s sleep by sleeping in later, going to bed earlier, or napping, as this disrupts your internal sleep regulation and makes future sleep problems more likely.

4. Leave Bed When Awake

If you wake up in the middle of the night and can’t get back to sleep within a reasonable time, get out of bed, go to another room, do something relaxing, and return to bed only when sleepy to avoid associating your bed with worry.

5. Wind Down Before Bedtime

Transition to lower light levels and quieter, more relaxing activities at least an hour or two before bedtime to prepare your body for sleep, avoiding work or stressful calls.

6. Maintain Dark Bedroom

Keep your bedroom as dark as possible, using sleep masks or room-darkening shades, to prevent early light exposure from disrupting your circadian rhythm and waking you prematurely.

7. Seek Morning Light

Open curtains and expose yourself to as much natural light as possible first thing in the morning to entrain your circadian rhythm; if possible, get outside or sit by an open window.

8. Avoid Sleep Obsession

Do not become overly fixated on your sleep, as trying too hard to sleep or worrying about it can undermine the natural process and perpetuate insomnia, since sleep is an automatic process you cannot force.

9. Chronic Insomnia Needs Pro Help

If insomnia persists beyond three months, seek assessment and targeted treatment from a behavioral sleep medicine specialist, as it often won’t resolve on its own, and Cognitive Behavioral Therapy for Insomnia (CBT-I) can be done via telehealth.

10. Don’t Use Alcohol for Sleep

Do not use alcohol as a sleep aid, as it may initially cause drowsiness but ultimately leads to fragmented sleep and middle-of-the-night awakenings.

11. Nap Short and Timed

If you nap, do so for about 20 minutes, setting an alarm, ideally seven to nine hours after waking, to avoid sleep inertia and preserve night sleep; avoid naps if you foresee returning to a non-napping work schedule.

12. Set Wake Alarm, Back-Time Bed

Determine your desired wake time, set an alarm to consistently wake up then, and back-time your bedtime based on your estimated sleep need, but don’t go to bed if you are not sleepy.

13. Structure Daily Life

Maintain regular mealtimes, exercise times, and other daily activities to support circadian entrainment and overall sleep health, and stay active during the day to avoid lethargy.

14. Assess Sleep Need by Day

Determine your individual sleep need by how you feel and function during the day (e.g., not tired, concentrating well), not by a fixed number like eight hours, as needs vary (typically between six and nine hours).

15. Limit Time in Bed

Avoid spending excessive time in bed beyond your actual sleep need, as this can lead to waking up in the middle of the night.

16. Filter Device Blue Light

Download and activate blue light filters on electronic devices, especially in the evening, to reduce blue light exposure that can disrupt circadian rhythm; if awake at night, use devices at a distance from your eyes.

17. Prescription Sleep Meds Short-Term

If considering sleep medication, opt for prescription medications designed for sleep, use them for short-term problems, and have a clear cutoff point under a physician’s guidance, as they are not intended for long-term use.

18. Skip OTC Sleep Aids

Avoid over-the-counter sleep aids (often antihistamines), as they are generally not very useful or helpful for sleep and are not recommended for chronic use.

19. Marijuana Not for Chronic Sleep

Do not use marijuana as a long-term solution for sleep, as it functions similarly to other sleeping pills and can lead to tolerance and withdrawal issues when used solely as a sleep aid.

20. Set Bedtime Reminder

If you struggle with delaying bedtime (e.g., doom scrolling), set an alarm on your phone for when you intend to start getting ready for bed to help transition into your wind-down routine.

21. Face Late Bedtime Consequences

Consistently wake up at your set time, even after a late night, as experiencing the daytime consequences (e.g., exhaustion) can strongly disincentivize future late bedtimes.

22. Insomnia Needs No Sleep Study

Insomnia can be diagnosed and treated behaviorally without a sleep study unless other underlying medical sleep disorders (like sleep apnea) are suspected.